Evaluation of platelet concentrate prescription in pediatric patients at a tertiary care hospital / Avaliação da prescrição de concentrado de plaquetas em pacientes pediátricos em hospital terciário

ABSTRACT Objective: To verify the adequacy of platelet concentrate prescription by pediatricians in different pediatric sectors of a general hospital. Methods: A cross-sectional study evaluating 218/227 platelet concentrate records in children and adolescents (zero to 13 years old), from January 2007 to April 2015, by the pediatricians of the emergency room, sick bay and intensive care unit. The requisitions were excluded in patients with hematological diseases and those without the number of platelets. Results: Children under 12 months received 98 platelet concentrates (45.2%). Most of the transfusions were prophylactic (165; 79%). Regarding the transfusion site, 39 (18%) were in the emergency room, 27 (12.4%) in the sick bay and 151 (69.6%) in the intensive care unit. The trigger, prescribed volume and platelet concentrate subtype were adequate in 59 (28.2%), 116 (53.5%) and 209 (96.3%) of the transfusions, respectively. Patients with hemorrhage presented adequacy in 42 (95.5%), while children without bleeding presented in 17 (10.3%). The most common inadequacy related to volume was the prescription above recommendation (95; 43.8%). Eight platelet concentrates were prescribed with subtype requests without indication. Conclusion: The results obtained in this study showed that transfusion of platelet concentrate occurred more adequately in children with active bleeding compared to prophylactic transfusion. There was a tendency to prescribe high volumes and platelet subtypes not justified according to current protocols. The teaching of transfusion medicine should be more valued at undergraduate and medical residency.

RESUMO Objetivo: Verificar a adequação na prescrição de concentrado de plaquetas por pediatras em diferentes setores da pediatria de um hospital geral. Métodos: Estudo transversal avaliando 218/227 fichas de requisição de concentrado de plaquetas de crianças e adolescentes (zero a 13 anos), de janeiro de 2007 a abril de 2015 pelos pediatras do pronto-socorro, enfermaria e unidade de terapia intensiva. Excluíram-se as requisições em portadores de doenças hematológicas e aquelas sem o número de plaquetas. Resultados: Crianças com menos de 12 meses receberam 98 prescrições de concentrado de plaquetas (45,2%). A maioria das transfusões foi profiláticas (165; 79%). Em relação ao local da transfusão, 39 (18%) foram no pronto-socorro, 27 (12,4%) na enfermaria e 151 (69,6%) na unidade de terapia intensiva. O gatilho, o volume prescrito e o subtipo de concentrado de plaquetas foram adequados em 59 (28,2%), 116 (53,5%) e 209 (96,3%) das transfusões, respectivamente. Prescrições para pacientes com hemorragia apresentaram adequação em 42 (95,5%) transfusões, enquanto para crianças sem hemorragia houve adequação em 17 (10,3%) vezes. A inadequação mais comum em relação ao volume foi a prescrição acima da recomendação (95; 43,8%). Foram prescritos oito concentrados de plaquetas sem indicação de solicitação de subtipos. Conclusão: Os resultados obtidos nesse estudo mostraram que a prescrição de transfusão de concentrado de plaquetas foi mais adequada em crianças com hemorragia ativa em comparação com a transfusão profilática. Houve tendência à prescrição de volumes elevados e de subtipos de plaquetas, o que não se justifica segundo os protocolos atuais. O ensino da medicina transfusional deve ser mais valorizado na graduação e na residência médica.

Trombocitopenia en el embarazo: gestacional, inmune y congénita / Thrombocytopenia in pregnancy: gestational, immune and congenital

La trombocitopenia afecta hasta el 10 por ciento de todos los embarazos y es un diagnóstico común y un problema en el manejo de las pacientes, ya que puede estar relacionado con condiciones prexistentes presentes en las mujeres en edad fértil, como la trombocitopenia inmune primaria y las trombocitopenias congénitas; o con trastornos intrínsecos del embarazo, como la trombocitopenia gestacional. Se recomienda que todas las mujeres embarazadas con recuento de plaquetas por debajo de 100 x 10(9)/L sean sometidas a una evaluación por el hematólogo y el obstetra. El análisis cuidadoso del momento del inicio de la trombocitopenia asociado a las manifestaciones clínicas y las pruebas de laboratorio específicas, es indispensable para proporcionar un diagnostico apropiado y una asistencia médica materna-fetal en el momento oportuno, en preparación para el desafío homeostático...

Thrombocytopenia affects up to 10 percent of all pregnant women and is a common diagnosis and a problem in the management of patients as it may be related to preexisting conditions in women of childbearing age, such as primary immune thrombocytopenia and congenital thrombocytopenia or intrinsic disorders of pregnancy as gestational thrombocytopenia. It is recommended that all pregnant women with a platelet count below 100 x 10(9) / L should undergo an evaluation by the hematologist and the obstetrician. Careful analysis of the time of onset of thrombocytopenia associated to clinical manifestations and specific laboratory tests are essential to provide appropriate diagnosis and maternal - fetal medical care at the right time, when preparing for the homeostatic challenge...

Recombinant human erythropoietin and blood transfusion in low-birth weight preterm infants under restrictive transfusion guidelines

To compare the number and volume of red blood cell transfusions [RBCTs] in very low birth weight infants under restrictive red blood cell transfusion guidelines with and without erythropoietin administration. In a controlled clinical trial conducted at the neonatal intensive care unit of Alzahra Hospital, Isfahan, Iran, between April 2002 to April 2004, 60 premature infants with gestational age up to 34 weeks, birth weight up to 1500 g, and postnatal age between 8 and 14 days were included. The newborns were randomized into 2 groups: Group 1 received 3 doses of 400 IU/kg erythropoietin per week for 6 weeks, and Group 2 received no treatment aside from their conventional medications. The 2 groups did not differ significantly with respect to their mean gestational age, birth weight and hematocrit at the study entry. Fewer transfusions were administered to those receiving erythropoietin [26.7% versus 50%, p=0.03], but there was no statistically significant difference between groups with respect to volume of transfusion. Compared with the placebo group, the infants receiving erythropoietin had a higher mean hematocrit [34% +/- 4.3 versus 29% +/- 5.9, p<0.001] and absolute reticulocyte count [57 +/- 19 versus 10 +/- 4.8 x 106, p<0.001] at the end of the study. We found no significant difference in the incidence of thrombocytopenia and leukopenia between the 2 groups. We conclude that when the restrictive RBCT guidelines were followed, treatment with erythropoietin can be useful in reduction of the number of RBCTs

Terapia transfusional em neoplasias e no transplante de medula óssea / Transfusion therapy in cancer and bone marrow transplantation

Nesta revisäo, säo discutidas as bases fisiopatológicas e aspectos práticos das transfusöes de hemoderivados em pacientes portadores de neoplasias ou submetidos a transplante de medula óssea. Säo particularmente enfatizadas as indicaçöes de concentrados de hemáceas, plaquetas e granulócitos e de componentes plasmáticos nas neoplasias e a abordagem hemoterápica da refratariedade plaquetária, da rejeiçäo ao enxerto, da incompatibilidade ABO, da infecçäo pelo citomegalovírus e da reaçäo do enxerto-contra-hospedeiro no transplante de medula óssea